Resources

School-based Mental Health Services

For over a decade, investigators from the Research and Training Center for
Children's Mental Health have been studying the role of school-based mental
health services in systems of care for children with emotional/behavioral
disorders and their families.

We believe that effective and integrated school-based mental health services
will be a key ingredient in the current transformation of children's mental
health services in America, and schools will be central to providing support
for the nation’s
youth in an increasingly complex societal context. Resources provided here
describe what we've learned about school-based mental health
services today, how we reached this point, and how good planning decisions
might be made in the future.

Recent federal initiatives and acts promote
the schools’ role
as an effective vehicle to meet the social and emotional needs of all children
while achieving the highest academic standards. The 1999 Report of the Surgeon
General on the Mental Health of the Nation, the 2001 No Child Left Behind
Act, and the 2003 report from the New Freedom Commission on Mental Health
have all focused attention on the potential of increasing the effectiveness
and capacity of school-based mental health services to improve the emotional
well being of all children as well as their academic achievement.

While these
federal initiatives have had an important role in increasing advocacy and
interest in school-based mental health services, their recommendations
lack the specificity needed for implementation at a scale necessary for significant
improvement in outcomes for children. For example, they have triggered
an explosion of interest and activity in school-based mental health programming,
yet outcomes for children who have emotional disturbances continue to be
the poorest of all disability groups (Wager et al., in press). The field
can be characterized as being fragmented and underdeveloped, and confused
by conflicting terminology and professional perspectives.

The School-based Mental Health Services Study

Study
4: The School-based Mental Health Services Study examined one of the components in the Center’s model
of factors contributing to implementation of an effective system of care;
namely, the promotion of collaboration between key agencies. It is essential
that effective collaboration between the school and mental health systems
exist in order to better serve individual children and families, and to facilitate
significant improvement in the mental health service delivery system.

The study investigated school-mental health collaboration in
the context of the overall mental health system, and will specifically investigate
two other factors in the Center’s model: financing methods that are
consistent with implementing an effective system of care, and mechanisms
that ensure strong family voice at all levels of the system.

School-wide Reform and Mental Health Policies in Urban Schools

Conducted from 1999 - 2004, Study 3 described
models of school reform operating in urban areas that served diverse populations,
and examined the relationship between reform activities and measures of student
functioning. The Urban School and Community Study (USACS) was designed to investigate
the relationship between reforms in regular education, special education and
mental health and outcomes for students who have emotional and behavioral disabilities.
The domains of outcomes at the student level included academic, emotional,
behavioral, and community functions. This study sought to explicate
the reform and restructuring activities of several different school-based models
associated with positive outcomes as they occurred in state and local contexts.

There were four key findings from this study:

(1) Urban schools engaged in more reform activities yield higher levels
of academic achievement for students who have emotional disturbances. The
amount of reform and improvement operating in a school and levels of math
achievement for students who have emotional disturbances was examined. The
amount of engagement in improvement and reform activities was found to be
correlated .36 with math achievement of students with emotional disturbances.
The size of this correlation is classified as “medium” by Cohen
(1988). Additionally, greater levels of reform were also associated with
higher levels of exposure to the general education curriculum for students
with emotional disturbances. These findings are important as they link policy
changes with improved outcomes for students with emotional disturbances served
in special education.

(2) Multiple models of delivering mental health services are operating
in urban schools. Schools that are actively engaging in reform and improvement
have been creative and, in some cases, have leveraged community relations
to increase services for these children. We have found several approaches
to delivering these services that include the following: (a) all services
provided by school personnel during school hours; (b) a combination of services
from school personnel and staff from community agencies who provide service
in the school; and (c) services provided by a community agency that acts
as a lead agency in implementing a large scale community-based service program
that includes the school system as a collaborator with the other child serving
agencies. Interestingly, these various models have produced a higher level
of service utilization for the students in this study as compared to estimates
from national studies.

(3) Students from ethnically diverse backgrounds, served in special education
due to emotional disturbances, display very high levels of psychopathology
and impaired functioning across multiple domains and this condition has persisted
since early childhood. Through interviews with parents, standardized
measures of psychopathology (the Child Behavior Checklist (CBCL), and functional
impairment (the Columbia Impairment Scale (CIS)), were administered along
with questions that ascertained the history of services used by the student.
CBCL scores for the first 158 students (average age of 11.8 years) revealed
that 73% were classified as either in the clinical or borderline range, indicating
significant emotional disturbance. Additionally, the majority of the students
(58%) were also classified in the clinical range of the CIS indicating substantial
impairment due to the emotional disturbances. According to reports from parents,
their child’s emotional problems were first noticed at an average age
of 5.4 years. The first service for these problems was received at average
age of 6.9 years. On average the youth were first placed in special education
classrooms at eight year of age or about third grade. Therefore, when the
amount of time these students spent in a special education program is compared
to their time in a general education classroom, this indicates these students
have spent 67% of their school careers enrolled in a special education program
(Kutash & Duchnowski, 2004).

(4) The School Improvement Index (SII) is a valid and reliable measure
of school reform including special education. This instrument warrants
widespread dissemination. Two types of psychometric studies have been conducted
on the SII. The validity of the SII was established through a study that
revealed the SII could discriminate between schools nominated as actively
engaged in reform and schools nominated as not actively engaged in reform
activities. The reliability of the SII has also been supported with high
interclass correlations (.85) between multiple raters independent of the
study. The psychometric properties of the SII are discussed in the article
by Duchnowski, Kutash, and Oliveira (2004).

Prevent-Teach-Reinforce: The School-Based Model of Individualized Positive Behavior Support

With this book, education professionals will learn how to prevent behavior problems by adjusting the curriculum and environment; teach proactive communication skills; and reinforce prosocial behavior and academic achievement.

These documents report on Phases I, II and III of SIP and report how the Children's Board of Hillsborough County can maximize investment in locally developed programsm and promote, implement, and sustain best practice for positive child and family outcomes.

This toolkit was produced as part of Developing Sustainable Infrastructure in Support of Quality Field-Based Practice (SIP) project, a collaborative effort of The Children’s Board of Hillsborough County Children’s Future Hillsborough, Family and School Support Teams (FASST), and the USF Department of Child and Family Studies. The toolkit has been designed to support implementation of the FASSTprogram as intended based on the current program theory.

This publication addresses how Florida may be able to scale-up and sustain over 3700 schools to implement Tier 1 PBS with fidelity. The process for scaling up implementation of School-Wide Positive Behavior Support with fidelity has been developed by the Office of Special Education Program’s Center on Positive Behavioral Interventions and Support and has been further examined by the State Implementation and Scaling up of Evidence-based Practices Center funded by OSEP.

This literature review attempts to provide a synthesis of the emerging literature pertaining to parent-to-parent support. The purpose of this review is twofold: (1) to uncover any evidence of the effectiveness of parent-to-parent support; and (2) to examine the concepts, constructs, and key elements of parent-to-parent that should be considered when designing a program (i.e., case management, training, and contact methods).

This report acquaints readers with the concept of family-driven care for children who have emotional and behavioral disturbances. From this context, the authors provide information about evidence-based practices that are effective interventions to help the children and their families. This information will help families, educators, and mental health service providers plan effective interventions for the children in their care.

This guide introduces and describes a model and associated training curriculum designed to support communities in their efforts to strengthen partnerships that better link Latino children and families with school personnel and service providers.

This document describes how the school and mental health systems can increase the involvement of parents in developing and assisting with services for their children with serious emotional disturbances.

The "Yellow Book" provides a discussion of barriers to school-based services with the intention of improving service effectiveness and capacity.

The Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study (NLTS2): Study Designs and Implications for Youth With Emotional Disturbance

This article describes design features of two longitudinal studies, the Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study (NLTS2), and to outline their potential implications for policy, practice, research, advocacy, and system development for children and youth with emotional disturbances (ED).

The four teacher-friendly manuals serve as guides to the implementation of evidence-based practices by special education teachers.

The Children and Youth We Serve: A National Picture of the Characteristics of Students with Emotional Disturbances Receiving Special Education

This article provides a national perspective of children and youth with emotional disturbances (ED) served in special education using data from the Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study-2 (NLTS2).

This free, downloadable manual provides teachers with guidance on how to involve families in the functional assessment and behavior support plan development process. A step-by-step process is described and helpful forms are provided.

The Guide is a tool that provides a framework for schools to assess their existing or proposed suicide prevention efforts (through a series of checklists) and provides resources and information that school administrators can use to enhance or add to their existing program. First, checklists can be completed to help evaluate the adequacy of the schools' suicide prevention programs. Second, information is offered in a series of issue briefs corresponding to a specific checklist.

This free, downloadable booklet provides a portfolio families can use to gather and share priorities and insights about their child in preparation for educational or service planning activities. Included within the form are sections that guide families to describe their child, share perspectives on their child's learning characteristics and identify desired outcomes.

Improving Outcomes for Students Through the Application of a Public Health Model to School Psychology: A Commentary

This overview contains a summary of the application of public health principles and concepts, which have the potential to improve outcomes for children served in our schools.

The Safe Schools/Healthy Students (SS/HS) Initiative in Pinellas County, FL, emerged as a part of a broader local effort to implement creative educational and mental health programs to support children and families. This initiative focused on capacity building, prevention, and intervention efforts and comprehensive evaluation to address the barriers to learning and enhance healthy development.

This article presents findings from a study comparing academic progress over five years for students with emotional and behavioral disorders and students with learning disabilities. Factors related to academic achievement (attendance, behavior offenses, type of special education setting, school mobility and early retention) were examined as to their contribution to achievement over time for these two groups.